Pivotable bone cutting guide useful for bone realignment and compression techniques

ABSTRACT

Instruments and surgical techniques may be used to correct a bone deformity, such as a bunion in which a metatarsal is misaligned with respect to a medial cuneiform. In some examples, a bone cutting guide is utilized to cut an end of the metatarsal and/or an end of the medial cuneiform to facilitate realignment of the bones. The cutting guide can have a pivotable cut guide surface along which a cutting instrument is translated to provide a precise bone cut. In some applications, after suitably preparing and aligning the bones, the bones are compressed together using a fixation pin. The fixation pin can be driven through one of the bones, into the second bone, and then further driven to compress the bones together.

RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application Ser.No. 62/117,747, filed Feb. 18, 2015, the entire contents of which arehereby incorporated by reference.

TECHNICAL FIELD

This disclosure relates generally to devices and methods for positioningand cutting bones.

BACKGROUND

Bones, such as the bones of a foot or ankle, may be anatomicallymisaligned. In certain circumstances, surgical intervention is requiredto correctly align the bones to reduce patient discomfort and improvepatient quality of life.

SUMMARY

In general, this disclosure is directed to bone cutting guide systemsand techniques for realigning and compressing bone together, such asbones cut using the cutting guide system. In some examples, a bonecutting guide has as a main block that has one or more guide memberspivotably attached to the main block. The one or more guide members eachdefine a guide surface, such as a planar surface, along which a cuttinginstrument can be placed in abutment and translated. In use, the mainblock can be positioned at a desired anatomical location, such asspanning a joint between two bones (e.g., a tarsal-metatarsal joint).Each guide member can be pivotably articulated relative to the mainblock to precisely position the cut guide surface provided by the guidemember for performing a cutting operation. For instance, in one specificapplication where the cutting guide is configured with two guidemembers, one guide member can be positioned to cut an end of a firstmetatarsal while the second guide member is positioned to cut anopposing end of a medial cuneiform. Depending on the configuration ofthe cut guide, the one or more guide members may also be elevationallyadjusted relative to the main block to position the guide members atdifferent elevations (e.g., heights) on the bones being operated upon.

After suitably positioning the one or more guide members relative to themain block and/or the bones being operated upon, the guide members maybe provisionally fixated to prevent further movement of the guidemembers during cutting. For example, each guide member may include oneor more fixation apertures configured to receive a fixation member, suchas a pin, wire, or screw. The clinician can insert a fixation memberthrough the fixation aperture of the guide member and into theunderlying bone, thereby fixating the guide member to the bone. In someconfigurations, the main block is detachable from the one or more guidemembers such that, after positioning and fixating the guide members, theblock is removed from the guide members to provide better access to theguide surfaces defined by the guide members. In either case, theclinician can use the guide surface defined by each guide member toguide a cutting instrument. For example, the clinician can place thecutting instrument in contact with the guide surface and translate thecutting instrument along the guide surface into the underlying bone,thereby using the guide surface to guide the cutting operation. Aftermaking one or more cuts using the guide members, the guide members canbe removed from the bone(s) to which the guide members are provisionallyfixated.

In addition to or in lieu of utilizing the cutting guide with pivotableguide members, a clinician may compress different bone portions togetherusing a bone fixation pin during a bone correction procedure. Forexample, the clinician may utilize a bone fixation pin that has athreaded leading end and a collar positioned along the length of theshaft. The collar may be a region of the shaft that has a largercross-sectional dimension (e.g., diameter) than at least the portion ofthe shaft distal of the collar. In use, the clinician can drive theleading end of the shaft into and through a first bone portion and intoa second bone portion until the collar contacts the first bone portion.The clinician may further drive the shaft toward the second boneportion, causing the collar to press upon the first bone portion andmove the first bone portion toward the second bone portion, therebycompressing the bone portions together. The clinician may fixate thebone portions together after compressing the bone portions. For example,the clinician may attach one or more bone plates to the bone portions tohold the bone portions together. Additionally or alternatively, inapplications where the bone fixation pin is detachable proximally of thecollar, the clinician may detach the bone pin proximally of the collarto leave an implant portion of the pin within the bones.

As one example application, a clinician may perform a tarsal-metatarsaljoint fusion procedure by preparing an end of a first metatarsal and anend of a medial cuneiform opposing the end of the first metatarsal. Theclinician may use a cut guide having one or more pivotably connectedguide members to prepare the ends of the bones using a cuttinginstrument. Alternatively, the clinician may prepare the end of one orboth bones using a cut guide having a different configuration or mayprepare the bones free hand (e.g., by cutting without a guide and/ormorselizing without a guide). In either case, the clinician can move thefirst metatarsal relative to a second metatarsal, either before or afterpreparing the ends of the bones, for example by adjusting the firstmetatarsal from an anatomically misaligned position with respect to thesecond metatarsal to a position that is anatomically aligned withrespect to the second metatarsal. In some examples, the clinician drivesthe bone fixation pin into the metatarsal and uses the bone fixation pinas a lever to manipulate the position of the first metatarsal relativeto the second metatarsal.

After optionally aligning the first metatarsal, the clinician can drivethe bone fixation pin through one side of the first metatarsal, out agenerally opposite side of the first metatarsal, and into the medialcuneiform. Alternatively, the clinician may drive the bone fixation pinthrough the medial cuneiform, out a generally opposite side of themedial cuneiform, and into the first metatarsal. In either application,the clinician can continue driving the bone fixation pin forward, thefirst metatarsal and medial cuneiform to compress together (e.g., byclosing the tarsal-metatarsal joint gap). The clinician can then fixatethe first metatarsal and medial cuneiform together, e.g., to hold thefirst metatarsal in an anatomically aligned position with respect to thesecond metatarsal.

In one example, a method of compressing adjacent bone portions togetheris described. The method includes providing a bone fixation pin having alength, a threaded end portion, and a collar, driving the threaded endportion into a first bone portion, and driving the threaded end portionthrough the first bone portion. The method further involves driving thethreaded end portion into a second bone portion until the collar is inapposition to the first bone portion and further driving the threadedend portion into the second bone portion to compress together the firstbone portion and the second bone portion.

In another example, a bone cutting guide is described that includes ablock and a first guide member. The first guide member is pivotallyattached to the block and includes a first guide surface defining afirst plane.

In another example, a method of cutting bones is described. The methodincludes positioning a projection of a block at least partially within aspace defined between bones, where the block is pivotally connected to afirst guide member. The method further involves aligning the first guidemember at a location to be cut, where a first guide surface of the firstguide member is positioned at the location to be cut. In addition, themethod includes fixing the first guide member to a bone and making afirst cut at the location to be cut by placing a cutting member inapposition to the first guide surface.

In another example, a method of aligning bone is described that includesinserting a first fixation pin in a first bone portion at a first angleand inserting a second fixation pin in a second bone portion at a secondangle, where the first and second angles being different. The methodfurther involves positioning the first and second bone portions withrespect to each other by manipulating the first fixation pin and thesecond fixation pin.

The details of one or more examples are set forth in the accompanyingdrawings and the description below. Other features, objects, andadvantages will be apparent from the description and drawings, and fromthe claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of a bone cutting guide.

FIG. 2 is a side elevational view of the bone cutting guide of FIG. 1.

FIGS. 3A and 3B are perspective views of another embodiment of a bonecutting guide showing example fixation aperture arrangements that can beused on the bone cutting guide of FIG. 1.

FIG. 4 is a perspective view of the bone cutting guide of FIG. 1 showingguide members of the bone cutting guide aligned at a skewed anglerelative to a block of the bone cutting guide.

FIG. 5 is a perspective view of the bone cutting guide of FIG. 1 showingthe guide members translated relative to a block of the bone cuttingguide.

FIG. 6A is a perspective view showing the block of the bone cuttingguide of FIG. 1 disconnected with the guide members of the bone cuttingguide in place.

FIG. 6B is a perspective view of another embodiment of a bone cuttingguide having a two portion block.

FIG. 7 is a side view showing the bone cutting guide of FIG. 1positioned between bones.

FIGS. 8-18 depict exemplary surgical methods and related components.

FIG. 19 is a block flow diagram of an example bone correction techniqueinvolving bone fixation pin compression that can be used in accordancewith the disclosure.

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description provides somepractical illustrations for implementing exemplary embodiments of thepresent invention. Examples of constructions, materials, and dimensionsare provided for selected elements, and all other elements employ thatwhich is known to those of ordinary skill in the field of the invention.Those skilled in the art will recognize that many of the noted exampleshave a variety of suitable alternatives.

Embodiments of the present invention include a bone cutting guide. In anexemplary application, the bone cutting guide can be useful during asurgical procedure, such as a bone alignment, osteotomy, fusionprocedure, and/or other procedures where one or more bones are to becut. Such a procedure can be performed, for example, on bones (e.g.,adjacent bones separated by a joint or different portions of a singlebone) in the foot or hand, where bones are relatively smaller comparedto bones in other parts of the human anatomy. In one example, aprocedure utilizing the bone cutting guide can be performed to correctan alignment between a metatarsal (e.g. a first metatarsal) and acuneiform (e.g., a first cuneiform), such as a bunion correction. Anexample of such a procedure is a lapidus procedure (also known as afirst tarsal-metatarsal fusion). In another example, the procedure canbe performed by modifying an alignment of a metatarsal (e.g. a firstmetatarsal). An example of such a procedure is a basilar metatarsalosteotomy procedure. As yet another example, the procedure can be afirst metatarsal-phalangeal joint (MTP) procedure. In some embodiments,the guide is disposable, such that it is discarded after the surgicalprocedure.

FIGS. 1 and 2 show an embodiment of a bone cutting guide 10. FIG. 1 is aperspective view of the bone cutting guide 10, while FIG. 2 is a sideelevational view of the bone cutting guide 10. As shown, the bonecutting guide 10 can include a block 20 having first and second sideends 20A and 20B as well as a top end 20C and a bottom end 20D. Theblock 20 can be made from a biocompatible material, such as abiocompatible metal or polymeric material. In the illustratedembodiment, the block 20 is shaped and dimensioned such that the block20 is capable of being gripped by hand during a surgical procedure. Forexample, the block 20 may include a recess 30 on one or more ends, suchas the end 20B as shown, to assist in gripping the block 20. However, inother embodiments the block 20 can have various shapes and dimensions.

As shown in FIG. 2, the block 20 can have one or more guide attachmentmembers 40. For the bone cutting guide 10 as shown, the one or moreguide attachment members 40 are pivotably attached on the end 20A of theblock 20 and rotatable about an axis extending through end 20A. In oneembodiment, the one or more guide attachment members 40 can be fixed tothe block 20 on an end of the members 40 nearest the top end 20C andfree on an end of the attachment members 40 nearest the bottom end 20D.In such a configuration, the one or more members 40 can extend orproject out from the end fixed to the block 20 in a direction that isgenerally parallel to an axis of the block 20 extending from the top end20C to the bottom end 20D. In other configurations of the block 20 thatinclude the guide attachment members 40, the members 40 can be fixed atvarious positions on the block 20 and extend out from the block 20 atany angle. In the embodiment shown, the members 40 define a generallycylindrical shape.

The block 20 can additionally include a projection 50 that extends outfrom an end, such as the bottom end 20D as illustrated, of the block 20.In an exemplary application, the bottom end 20D of the block 20 can bepositioned so as to interface with, for instance, two bones while theprojection 50 is configured to extend into a space defined between thebones (e.g. a joint between two bones, or a space between two boneportions of a fractured bone), thereby helping to anatomically align theguide with respect to the space. As such, depending on the applicationof the bone cutting guide 10, the projection 50 may have a width W thatis dimensioned so as to be able to fit into the space defined betweenbones as desired. As shown, the projection 50 may be a planar memberhaving two surfaces separated by a distance. In the embodiment shown,the distance, W, in generally constant, and a leading edge of theprojection 50 is provided with a wedge or taper to facilitate insertioninto a space. In other embodiments, the distance (e.g., thickness and/orwidth) may vary from a narrower dimension near the leading region to awider dimension near a proximal region.

The bone cutting guide 10 can also include one or more guide memberspositionable with respect to block 20 which, in the illustrated example,are shown as a first guide member 60 and a second guide member 70. Theguide members 60 and 70 may be made of metal or any other suitablematerial. The guide members 60 and 70 can each have a flange 80 and asupport 90. The flange 80 is connected to the support 90, and in someembodiments the flange 80 and the support 90 can be one integralcomponent. As will be discussed, the flange 80 may mate with a pinprojecting from block 20 to form a hinge about which the flange and/orsupport 90 can rotate.

Each flange 80 may include a first guide surface 100A configured toguide a cutting instrument, such as a saw blade, in a desired plane. Insome embodiments, one or both flanges include a second guide surface100B. The first and second guide surfaces 100A and 100B can be adjacentsurfaces facing one another with a space (e.g., opening or gap) definedin the flange 80 between the first and second guide surfaces 100A and100B. The space may be configured (e.g., sized and/or shaped) forreceiving a cutting instrument, such as a saw blade. The surfaces 100Aand 100B can be configured for holding the cutting instrument in adesired plane during a cutting operation. For example, in use, aclinician may position a cutting instrument (e.g., saw blade, rotaryburr, osteotome) against first guide surface 100A, against second guidesurface 100B, and/or in the space between the first and second guidesurfaces. The clinician may then translate the cutting instrument alongand/or between the guide surfaces, thereby using the guide surfaces toguide a cut made on bone.

In general, the lateral distance between a surface of the block 20 andthe first guide surface 100A will define an amount of bone to be cut. Insome configurations, the distance is adjustable to adjust the amount(e.g., width) of bone cut. In some embodiments, this distance is betweenabout one to about two and a half millimeters. In some embodiments, aheight of the first guide surface 100A is set to correspond to a knowncutting instrument length when the guide is positioned on bone, suchthat cuts of known depths can be made relying on the guide surface.

As shown, the first guide surface 100A can be a surface of the flange 80extending from an edge of the flange 80 that connects to the support 90.The second guide surface 100B can be a surface of the flange 80extending from an edge of the flange 80 that interfaces with the block20. In the illustrated embodiment, the guide surfaces 100A and 100B areboth single, continuous surfaces lacking any openings on their face. Insome embodiments (not illustrated), a guide surface, for instance thesecond guide surface 100B, can contain a gap or opening such that theguide surface is not a single, continuous surface.

In general, the first guide surface 100A defines a first plane and thesecond guide surface 100B defines a second plane. As shown, the firstguide surface 100A and the second guide surface 100B can be configuredsuch that the first plane is parallel to the second plane, with a space(defined in the flange 80) between the first and second guide surfaces.In further embodiments (not illustrated), the guide surfaces 100A and100B can be configured such that the first and/or second planes areskewed. Although the guide surfaces 100A and 100B are shown to be on theflange 80, in other embodiments, the guide members 60 and/or 70 may havethe guide surfaces 100A and 100B (and thus the space defined between theguide surfaces 100A and 100B) at other locations. For example, the guidesurfaces 100A and 100B may be included as part of the support 90, suchthat the space defined in the flange 80 between the guide surfaces 100Aand 100B would instead be defined in the support 90.

The support 90 of each guide member 60 and 70 can be used to align thecut guide with an anatomic axis (e.g., long axis, anterior-posterioraxis) of a bone or a foot. In the embodiment shown, support 90 isgenerally linear, although in other embodiments, support 90 may includea curve in on or more planes. In some embodiments, not shown, thesupport 90 is adjustable relative to flange 80 to improve its anatomicfit when bone cutting guide 10 is installed on a patient. For example,an end of the support 90 can be provided with an adjustment screw toelevationally adjust the support with respect to the bone on which cutguide 10 is positioned.

The support 90 of each guide member 60 and 70 can include one or morefixation apertures 110A and/or 110B. The fixation apertures 110A and110B may extend through the support 90. Each of the fixation apertures110A and 110B can receive, for example, a preparation fixation pin thatextends through the support 90 at the fixation apertures 110A and 110Bsuch that an end of the preparation fixation pin can be fixed to a bone.In the illustrated embodiment of FIG. 1, the fixation apertures 110A and110B are generally vertical and are located on opposite ends of thesupport 90. Specifically, in the embodiment shown, the fixationapertures 110A and 110B as shown are located on opposite ends of alongitudinal axis of the support 90 that extends perpendicular to theflange 80, and thus the first and second guide surfaces 100A and 100B.However, in other embodiments, the support 90 can extend at variousangles from the flange 80 and the one or more fixation apertures 110Aand 110B can be positioned at various locations on the guide members 60and 70 (e.g. the flange 80). Further, either or both supports 90 caninclude any desired number of fixation apertures (e.g., 1, 2, 3, or 4)aligned at any desired orientation.

The one or more fixation apertures provided on each of first guidemember 60 and second guide member 70 can have a variety of differentconfigurations. FIGS. 3A and 3B are perspective views of anotherembodiment of bone cutting guide 10 showing example fixation aperturearrangements. FIG. 3B shows the bone cutting guide of FIG. 3A with block20 disconnected for purposes of illustration. As shown, at least onefixation aperture 110A, 110B is provided at a skewed angle relative to avertical axis of the support 90, the first surface 100A, a vertical axisof the block 20, and/or at least one other fixation aperture. In someembodiments, the skewed angle is between about 5 degrees and about 45degrees from vertical. In certain embodiments, the skewed angle isbetween about 10 degrees and about 30 degrees. In a specific embodiment,the skewed angle is about 20 degrees. The skewed angle can be useful forguiding a preparation fixation pin into bone at a known angle other thanvertical. In the embodiment shown in FIG. 1B, one of the supports 90 hasvertical fixation apertures 110A and 110B, and the other of the supportshas vertical fixation apertures 110A and 110B and skewed fixationapertures 110C and 110D.

With further reference to FIGS. 1 and 2, first guide member 60 and/orsecond guide member 70 may be pivotally attached to the block 20 suchthat the guide member 60 and/or 70 can pivot with respect to the block20. For example, in one embodiment, to pivotally attach the guide member60 and/or 70 to the block 20, the guide member 60 and/or 70 may includean aperture 120 that receives the guide attachment member 40 of theblock 20. The aperture may define a cylindrical shape sized to mate withthe attachment member 40. In the illustrated embodiment, the aperture120 is included on an end of the flange 80 adjacent the first and secondguide surfaces 100A and 100B. In other variations, the aperture 120 canbe positioned at other locations on the guide member 60 and/or 70.Further, in some embodiments (not shown), the block 20 can include theaperture 120 and the guide member 60 and/or 70 can include theattachment member 40.

In either configuration, the aperture 120 can be aligned with the guideattachment member 40, and the guide member 60 and/or 70 can be attachedto the block 20 by mating the attachment member 40 and the aperture 120.In some embodiments, the pivotable connection established between guidemembers 60 and/or 70 and block 20 is further adjustable to adjust theelevation of the guide members relative to the block. For example, theguide member 60 and/or 70 may attach to block 20 by sliding upwardlyalong the attachment member 40 until the guide member 60 and/or 70contacts a bottom surface of the block 20. The guide member 60 and/or 70can be free (e.g., open) at an end opposite from the end contacting theblock 20, which can allow the guide member 60 and/or 70 to translatealong the guide attachment member 40 such that the guide members 60 and70 may be at different elevations with respect to the block 20. In someembodiments, the block 20 can be detached from the guide members 60and/or 70 while the guide members are held on bone by preparationfixation pins. In such embodiments, a retention mechanism may beprovided to facilitate retaining the guide members to the block duringhandling and prior to installation of the guide on bone. For example,the retention mechanism may include a magnet disposed within the block,a mechanical feature, and/or a surface treatment, such as a coating orroughening, to increase friction between the guide members and theattachment members.

In some examples, the guide member 60 and/or 70 is attached to the block20 in a way that allows the guide member 60 and/or 70 to independentlypivot with respect to the block 20 and to independently translate withrespect to the block 20. The guide member 60 and/or 70 can be pivotallyattached to the block 20 in numerous ways and at various locations onthe block 20. For instance, as illustrated, the guide members 60 and 70are pivotally attached to the block 20 on the same end 20A of the block20 and radially spaced from each other on that end 20A. In thisconfiguration, the guide members 60 and 70 pivot about the block 20 atan end 20A opposite an end 20B of the block 20. Additionally, theembodiment shown has the guide members 60 and 70 configured to pivotwith respect to the block 20 about parallel or skewed axes of rotation.In other variations, the guide members 60 and 70 can be attached to theblock 20 at different locations, such as on opposite ends 20A and 20B ofblock 20.

Depending on the location of where guide members 60 and 70 pivotablyattach to block 20, separate bone cutting guides may be provided forleft-side and right-side anatomies (e.g., a guide for a left foot and aguide for a right foot). In the embodiment shown in FIG. 1, the bonecutting guide 10 is configured for a left foot. In some embodiments, abone cutting guide (or component thereof) is configured for a right footand would be a mirror image of the bone cutting guide 10 (or a componentthereof, such as guide members 60 and/or 70) configured for a left foot.In other embodiments, such as that shown in FIGS. 3A and 3B, the bonecutting guide (or components thereof) is ambidextrous and can beconfigured for use on either foot. In some such embodiments, the guidemembers 60 and/or 70 can be detached from the block 20, turned over, andreattached to the block to work on the opposite foot. As shown, labelingcan be provided to facilitate configuring the bone cutting guide (orcomponent thereof) for either foot.

FIG. 4 illustrates a perspective view of the bone cutting guide 10 ofFIGS. 1 and 2. In the illustrated embodiment, the guide members 60 and70 are pivotally attached to the block 20. A location where a bone is tobe cut can vary depending on the application of the bone cutting guide10. In some applications, the guide member 60 and/or 70 can be alignedat the location to be cut by appropriately positioning the block 20 suchthat the first and/or second guide surfaces 100A and 100B, or a spacedefined between the guide surfaces 100A and 100B, is located at thelocation to be cut. For example, when performing a tarsal-metatarsalfusion procedure, block 20 may be positioned over a tarsal-metatarsaljoint (e.g., with projection 50 inserted into the joint).

In some embodiments, it may be desirable to adjust the location of theguide member 60 and/or 70 relative to the block 20 so that the guidemember 60 and/or 70 is aligned at the location desired to be cut. In theexample shown in FIG. 4, the guide member 60 has been pivoted about theblock 20 so that the guide member 60 is appropriately aligned at thelocation to be cut. Specifically, the guide member 60 has been pivotedabout the block 20 so that the first guide surface 100A and the openingdefined between the guide surfaces 100A and 100B is positioned at thelocation desired to be cut. Similarly, the guide member 70 has beenaligned at a second location to be cut by pivoting the guide member 70about the block 20 so that the guide surface 100A and the space definedbetween the guide surfaces 100A and 100B is positioned at the secondlocation desired to be cut. Depending on the particular application, theguide members 60 and 70 can be pivoted about the block 20 to differingdegrees. By pivotally attaching the guide member 60 and/or 70 to theblock 20, bone cuts can be made at a wide range of locations. Further,because the projection 50 can be positioned within a joint, alongitudinal axis of the cut can be generally parallel with theprojection while the plane of the cut can be angularly adjusted relativeto the projection as desired.

FIG. 5 shows a perspective view of the bone cutting guide 10 of FIGS. 1,2, and 4. As described previously, the guide members 60 and 70 can beattached to the block 20 in a manner that allows the guide members 60and 70 to translate with respect to the block 20, such as up and downalong the respective guide attachment members 40. Configuring the guidemembers 60 and 70 to translate with respect to the block 20 allows theguide members 60 and 70 to be positioned at differing elevations, suchas differing elevations along the attachment members 40. For instance,in the example shown in FIG. 5, the guide member 60 is at a higherelevation along its respective guide attachment member 40 relative tothe guide member 70 along its respective guide attachment member 40.This can be beneficial, for example, where the block 20 is positionedbetween two bones having differing elevations (e.g., differing heights).In such an application, the guide members 60 and 70 can translate withrespect to the block 20 (e.g. along the respective guide attachmentmembers 40) so that each guide member 60 and 70 rests on the respectivebone on each side of the block 20, even though the bone on each side ofthe block 20 is positioned at a different elevation.

Additionally, configuring the guide members 60 and 70 to translate withrespect to the block 20 can allow the block 20 to be removed, forinstance from a space defined between bones, while the guide members 60and 70 remain in place. In the embodiment of the bone cutting guide 10shown, the guide members 60 and 70 are free at an end opposite an endthat can contact the block 20. When so configured, the block 20 may bepulled away from the guide members 60 and 70 without disturbing theguide members 60 and 70, which may provide more working room during asurgical procedure.

FIG. 6A shows the guide members 60 and 70 disconnected from the block20. In some embodiments, such as the embodiment shown in FIG. 6B, theblock 20 is configured such that a portion of it can be detached whileleaving the guide members 60 and 70 coupled to the attachment members40, which allows the guide members to remain coupled at any angle. Insuch embodiments, the block 20 has a first portion 200A connected to theattachment members 40 and a second portion 200B detachable from thefirst portion.

FIG. 7 shows the bone cutting guide 10 positioned for use in cuttingbones 130 and 140. In particular, FIG. 7 shows bone cutting guide 10positioned on a tarsal-metatarsal joint with option projection 50inserted into the joint. First guide member 60 in this example ispositioned on first metatarsal 140 (e.g., to cut an end of the firstmetatarsal during a fusion procedure). Second guide member 70 in theexample is positioned on medial cuneiform 130 (e.g., to cut an end ofthe medial cuneiform opposite the end of the first metatarsal beingcut).

As shown, the bone cutting guide 10 can be positioned over and/or in aspace defined between the bones 130 and 140. In particular, block 20 ofbone cutting guide 10 can be positioned over and/or in a space definedbetween the bones 130 and 140. For embodiments where the block 20includes the projection 50, the block 20 can be positioned at the spacedefined between the bones 130 and 140 such that the projection 50extends into the space defined between the bones 130 and 140. Theprojection 50 can, for example, assist in positioning and spacing thebones 130 and 140.

The guide members 60 and 70 may each be aligned at respective locationson the bones 130 and 140 desired to be cut. For example, the guidemembers 60 and 70 may be rotated relative to block 20 until the firstguide surface 110A and/or the second guide surface 100B of each guidemember are positioned at respective locations on the bones 130 and 140desired to be cut. In embodiments having guide surfaces 100A and 100B,the space defined between the guide surfaces 100A and 100B can bepositioned at the respective locations on the bones 130 and 140 desiredto be cut. Aligning the guide members 60 and 70 at the respectivelocations to be cut can include pivoting one or both guide members 60and 70, for example at the apertures 120, about the block 20 asnecessary. In addition, in some embodiments, aligning the guide member60 and/or 70 can include translating the guide member 60 and/or 70relative to and along the block 20 such that an elevation of the guidemember 60 and/or 70 is adjusted, for instance, to match an elevation ofthe respective bone 130 and/or 140. The guide members 60 and 70 can bealigned such that cuts made to the bones 130 and 140 using therespective guide members 60 and 70 are parallel cuts. In otherembodiments, the guide members 60 and 70 can be aligned such that thecuts made to the bones 130 and 140 are at non-parallel angles relativeto each other.

Once the guide members 60 and/or 70 have been aligned at respectivelocations to be cut, the guide members 60 and/or 70 can be fixed to therespective bones 130 and 140. In the illustrated embodiment, bonefixation pins (FIG. 16) may be inserted through the fixation apertures110A and/or 110B of the guide members 60 and/or 70 to fix the guidemembers 60 and/or 70 to the respective bones 130 and 140. An end of abone fixation pin can be inserted through, for example, the fixationaperture 110B in the support 90 such that the end of the bone fixationpin is fixed to the respective bone 130 or 140.

After aligning and fixing the guide members 60 and/or 70, the block 20may be removed from the space defined between the bones 130 and 140. Theblock 20 can be removed by pulling the block 20 away from the bones 130and 140 in a direction opposite the bones 130 and 140. As such, inembodiments where the block 20 includes the projection 50, theprojection 50 can also be removed from the space defined between thebones 130 and 140 by removing the block 20. In this manner, the block 20can slide out from the guide members 60 and 70 while the guide members60 and 70 remain fixed to the respective bones 130 and 140.

The bones 130 and 140 can be cut at the desired locations where theguide members 60 and/or 70 have been aligned. For example, a cuttingmember (e.g. a saw blade) can be placed in apposition (e.g., paralleland/or abutting arrangement) to the first guide surface 110A or, in someembodiments, inserted through the space defined between the first andsecond guide surfaces 100A and 100B to cut the respective bone 130and/or 140. The guide surfaces 100A and 100B can serve to direct thecutting member to the location of the bone 130 or 140 to be cut, whichin many applications of the bone cutting guide 10 can be a preciselocation.

When the bones 130 and/or 140 have been cut, the guide members 60 and/or70 can be removed. Removing the guide members 60 and/or 70 may includeremoving any preparation fixation pins from the bones 130 and/or 140 aswell as from the guide members 60 and/or 70. In some embodiments, thebones may then be compressed together and one or more bone plates may beapplied.

An exemplary method and related components will now be described withreference to FIGS. 8-18. As shown in FIG. 8, after making an incision, acut guide (e.g., bone cutting guide 10 described with respect to FIGS.1-7) can be placed into the incision. When configured with a projection,the projection can be inserted into a joint-space (e.g.,metatarsal-cuneiform joint-space) to temporarily secure the guide in thejoint. Further, inserting the projection of the block into thejoint-space can be helpful to align the block and cutting surfaces withan anatomical axis of the bone to be cut. Such alignment may facilitatethe proper placement of bone fixation pins for further positioning asdescribed herein.

As shown in FIG. 9, a first guide member (e.g., the distal guide member)can be articulated with respect to the block to align it with a boneanatomic axis, such as the anatomic axis of a first metatarsal (e.g.,the long or anterior-posterior axis of the bone). Before or afteraligning the first guide member, a second guide member (e.g., theproximal guide member) can be articulated with respect to the block toalign it with an axis of a second bone, such as a medial cuneiform(e.g., the long or anterior-posterior axis of the bone). Alignment mayform an angle approximately equivalent to the angle of correctionrequired for the patient's bone procedure.

As shown in FIG. 10, one or more (e.g., two) bone preparation fixationpins 200 can be inserted into fixation apertures of the first guidemember. Additionally, one or more (e.g., two) bone fixation pins can beinserted into the fixation apertures of the second guide member. In theembodiment shown, the fixation pins in the first guide member areinserted through fixation apertures at a skewed (e.g., 20 degree) anglerelative to the fixation pins in the second guide member relative to along axis of the bone. The pins can be parallel to each other to helpdetermine any planar rotation about a central axis of the joint prior toor during fixation of the bones in their final position.

FIG. 11 illustrates a perspective view of an embodiment of bonepreparation fixation pins 200. The bone preparation fixation pinsinclude a first end 210 and a second end 220. The second end can bepointed and optionally threaded. As described herein, the bonepreparation fixation pins can be used in to fixate a bone cutting guideto one or more bones and/or to provisionally position bones with respectto each other (e.g., rotationally, translationally, and/orelevationally) after removal of the guide and prior to installation of abone plate.

In FIG. 12, the block has been pulled out of the joint (vertically),uncoupling the guide members, which remain in place.

In FIG. 13, a cutting instrument (e.g., oscillating saw) is used to makethe metatarsal cut through the cut slot on the first guide member. Thecutting instrument can also be used to make the cut on the cuneiformthrough the cut slot on the second guide member.

In FIG. 14, the guide members have been pulled vertically up and off ofthe pins. The cut bone pieces can then be removed.

FIG. 15 shows schematic images that depict how the bone preparationfixation pins 200 can be used to align the bones with respect to eachother. As shown, the pins can serve as a navigation tool for aligningone bone relative to the other in preparation for fusion. The pins canbe used to move the first metatarsal from an anatomically misalignedposition with respect to the second metatarsal to an anatomicallyaligned position with respect to the second metatarsal. For example, thefirst metatarsal may be moved in a frontal plane, transverse plane,and/or sagittal plane relative to the second metatarsal to move from ananatomically misaligned position to an anatomically aligned position.Additional details on bone alignment instruments and techniques that canbe utilized in conjunction with the present disclosure are described inU.S. patent application Ser. Nos. 14/981,335, filed Dec. 28, 2015, and62/293,189, filed Feb. 9, 2015, the entire contents of which areincorporated herein by reference.

In FIG. 14, the pins 200 may be used to rotate the distal bone in afrontal plane until the distal pins (inserted into the first metatarsal)are aligned with the proximal pins (inserted into the medial cuneiform)when the correction is complete. Having one or more pins on each bonecan help guide the positioning of the bones in both rotation andtranslation. The pins can make it easier to manually manipulate thebones, serving as a “joystick.” In some embodiments, the pins are anattachment point for a device to compress the joint in preparation forfusion. In some embodiments, a bone graft or other material is deliveredto the joint site prior to compressing the bones and/or permanentlyfixating the joint.

FIG. 16 shows a perspective view of an embodiment of a bone fixation pinthat can be used to compress bones (e.g., a first metatarsal and medialcuneiform) together during a bone correction procedure. As shown, a bonefixation pin 300 includes a shaft 302 that has a first end 310 (whichmay be referred to as a distal or leading end) and a second end 320(which may be referred to as a proximal or trailing end). The bonefixation pin 300 further includes a collar 330 (which may be referred toas an olive in some embodiments) positioned along the length of theshaft. The collar 330 may be a region of shaft 302 that has a largercross-sectional dimension (e.g., diameter) than a remainder of theshaft. For example, the collar 330 may be a disc or cylinder shape, orbulbous or other shape, that projects outwardly away from a remainder ofthe shaft 302 (or at least a distal portion of the shaft that isintended to be inserted into bone).

Shaft 302 of bone fixation pin 300 may be threaded along at least aportion of its length. For example, shaft 302 may be threaded from firstend 310 toward collar 330 along a portion of its length. In someexamples, shaft 302 is threaded from the distal tip toward collar 330 atleast 10% of the length of the shaft between the distal tip and distaledge of collar 330, such as from 10% of the length to 65% of the length.While fixation pin 300 can utilize a variety of different types ofthread patterns, in some configurations, the threading provides a lagscrew on the leading end of the bone fixation pin.

Depending on the particular application, bone fixation pin 300 may havea length ranging from 50 millimeters to 200 millimeters. Collar 330 insuch examples may be positioned along the length of the shaft such thatthe distal edge of the collar ranges from about 20 mm to about 60 mm(e.g., 25 mm to 50 mm) from the distal-most tip of the pin, such asabout 30 mm or about 40 mm. In some examples, collar 330 is positionedat a location effective to allow bone fixation pin 300 to be driven intoand through one bone (e.g., a first metatarsal, medial cuneiform) andinto but not through an adjacent bone (e.g., the other of the firstmetatarsal, medial cuneiform), with collar 330 being located to preventthe pin from being driven through the adjacent bone (e.g., by bearingagainst the first bone). Although the dimensions can vary, shaft 302 mayhave a diameter in the range of from 1.2 millimeters to 3.5 millimeters,outside of collar 330, while the collar may have a diameter ranging from0.1 mm to 10 mm larger than the shaft.

Bone fixation pin 300 can be used to fix one or more bones in aparticular position as desired for a surgical procedure. For example, atleast one bone fixation pin 300 may be inserted into adjacent bones,crossing the joint space between the bones, and used to compress thebones together prior to the installation of a bone plate. For example,in some applications, adjacent bones are compressed by providing a bonefixation pin having a length, a threaded end portion, and a collar. Thethreaded end of the bone fixation pin may be driven into and through afirst bone portion and into a second bone portion until the collar is inapposition to the first bone portion. The threaded end of the bonefixation pin may be further driven into the second bone portion tocompress the first bone portion and the second bone portion together. Insome embodiments, a second bone fixation pin is applied and used in thesame manner. For example, the second bone fixation pin may be insertedthrough the second bone and into the first bone.

In different applications, the bone fixation pin(s) 300 can be removedafter compressing the bone portions together or at least a portion ofthe bone fixation pin can be used as an implant that remains in the boneafter completion of the surgical procedure. In one exampleconfiguration, bone fixation pin 300 is configured to be detachableproximally of collar 330, such as at a proximal edge of the collar. Aproximal portion of bone fixation pin 300 may be detachable from aremainder of the pin by providing an area of weakened mechanicalstrength (e.g., area of reduced cross-section) configured topreferentially break or shear relative to a remainder of the pin. Insome such configurations, fixation pin 300 may be sheared into animplantable portion that remains in the bone and a detachable andremovable portion that is extracted from the patient. Fixation pin 300may be sheared, for example, by increased torque or twisting force tothe pin, causing the pin the cleave at the mechanically weakened area.

FIG. 16 further illustrates fixation pin 300 as having an optionalimplantable portion 340 and detachable portion 350, where a detachmentregion (e.g., mechanical weakening) is provided between the twoportions. To drive fixation pin 300 into bone in such an example, thepin may have a main drive engagement surface 360, such as a surface onor adjacent the second end 320 that can be engaged with a mechanicaldriving instrument (e.g., drill, pliers). The fixation pin 300 mayfurther have a secondary drive engagement surface 370 on or adjacent to(e.g., distal of) collar 330. Such secondary drive engagement surfacecan be engaged with the mechanical driving instrument after detachmentof the implantable portion 340 from the detachable portion 350. This canbe useful to further drive or remove the implantable portion into orfrom bone after detachment, if needed.

The bone fixation pins and the method described may be used in asurgical procedure along with a bone cutting guide, such as embodimentsof the bone cutting guides described herein, or may be usedindependently of such guides. Further, in some embodiments, afterdriving the threaded end portion into the first bone portion and priorto driving the threaded end portion into the second bone portion, theposition of the first bone portion can be adjusted (e.g., rotationally,translationally, and/or elevationally) relative to the position of thesecond bone portion by a manipulation of the bone fixation pin.

A specific embodiment is shown in FIGS. 17A and 17B. As shown, a bonefixation pin can be inserted from the metatarsal into the cuneiform,with a distal-medial to proximal-lateral trajectory, to compress thejoint and provide provisional fixation of the alignment correction. Asecond bone fixation pin can be inserted from the cuneiform into themetatarsal, crisscrossing the first bone fixation pin for additionalprovisional fixation. In this example, the distal bone preparationfixation pins are still rotated in the frontal plane. However, they maybe aligned and parallel with the proximal bone preparation fixation pinsprior to the installation of the bone fixation pins. While FIGS. 17A and17B show one example angular orientation of bone pins 300, other angularorientations can be used.

In FIG. 18, the four bone preparation fixation pins have been removed. Adorsal-medial bone plate 400 has been applied above (e.g., dorsally) thecrossing bone fixation pins, and a plantar-medial bone plate 410 hasbeen applied below (e.g., plantarly) the crossing bone fixation pins.For example, the two bone plates may be applied above and below the bonepreparation fixation pins prior to removing the pins (e.g., such thatthe plates do not cover the holes created by the bone fixation pins) andthe pins thereafter removed. In FIG. 18, the bone fixation pins areshown removed, e.g., after attachment of the bone plates. Additionaldetails on example bone plates that can be used are described in U.S.patent application Ser. No. 14/990,368, filed Jan. 7, 2016, the entirecontents of which are incorporated herein by reference.

FIG. 19 is a block flow diagram of an example bone correction techniqueinvolving bone fixation pin compression that can be used in accordancewith the disclosure. Specific steps of the technique of FIG. 19 can beperformed utilizing techniques and/or instruments discussed herein. Asshown, the example technique of FIG. 19 includes mobilizing atarsal-metatarsal joint by releasing soft tissue and/or obstructing bone(500). After customary surgical preparation and access, the clinicianmay mobilize the tarsal-metatarsal joint by inserting a cuttinginstrument (e.g., saw, rotary bur, osteotome) at least partially betweenthe first metatarsal and medial cuneiform. The clinician may use thecutting instrument to release soft tissues and/or excise the plantarflare from the base of the first metatarsal. Excising the plantar flaremay involve cutting plantar flare off the first metatarsal so the faceof the first metatarsal is generally planar. In some applications, thedorsal-lateral flare of the first metatarsal may also be excised tocreate space for the correction procedure.

The technique of FIG. 19 further involves preparing the end of the firstmetatarsal and/or the opposed end of the medial cuneiform (502). Toprepare the end of the first metatarsal and the end of the medialcuneiform, a tissue removing instrument can be applied to the ends ofthe bones. A bone cutting guide, such as bone cutting guide 10 havingone or more rotatable guide members described herein, can be applied tothe tarsal-metatarsal joint to guide the tissue removing instrument. Asdiscussed, the one or more guide members of the bone cutting guide canbe aligned to position a guide surface at the location on the bone wherethe tissue removal instrument is to be directed. Independent of whethera cutting guide is used or the specific configuration of the cuttingguide, a cutting instrument may be applied to transect each bone andthereby form a new end surface, e.g., by inserting the cuttinginstrument along a guide surface and/or through a slot defined on by theguide. Additionally or alternatively, the tissue removing instrument canbe applied to the end face of each bone to morselize at least a portionof the end face.

Independent of the specific technique used to prepare the end of thefirst metatarsal and/or the opposed end of the medial cuneiform (502),the technique of FIG. 19 includes moving the first metatarsal to helpcorrect the anatomical misalignment (504). The first metatarsal can bemoved relative to the second metatarsal before and/or after preparingthe end of the first metatarsal and/or the opposed end of the medialcuneiform. In some applications, one or more provisional bone fixationpins are inserted into the first metatarsal and/or medial cuneiform(e.g., to attach bone cutting guide 10 at the tarsal-metatarsal joint)and used to guide alignment. For example, the clinician may grasp aprovisional bone fixation pin inserted into a first metatarsal and usedthe pin to manipulate movement and realignment of the first metatarsalrelative to the second metatarsal.

In some applications, the first metatarsal is moved from an anatomicallymisaligned position (e.g., characterized by a bunion deformity) to ananatomically aligned position. In some embodiments, an “anatomicallyaligned position” means that an angle of a long axis of a firstmetatarsal relative to a long axis of a second metatarsal is about 10degrees or less in the transverse plane or sagittal plane. Depending onthe application, anatomical misalignment can be corrected in both atransverse plane and a frontal plane. In the transverse plane, a normalintermetatarsal angle (“IMA”) between a first metatarsal and a secondmetatarsal may be less than about 9 degrees (e.g., less than 6 degrees).An IMA of between about 6 degrees and about 13 degrees (e.g., betweenabout 9 degrees and about 13 degrees) may be considered a mild ormoderate misalignment of the first metatarsal relative to the secondmetatarsal. An IMA of greater than about 16 degrees may be considered asevere misalignment of the first metatarsal relative to the secondmetatarsal. In some embodiments, methods in accordance with thedisclosure involve anatomically aligning the first metatarsal relativeto the second metatarsal) by reducing the IMA from over 10 degrees toabout 10 degrees or less (e.g., to an IMA of less than 6 degrees, suchas to an IMA of about 1-5 degrees), including to negative angles ofabout −5 degrees or until interference with the second metatarsal, bypositioning the first metatarsal at a different angle with respect tothe second metatarsal.

With respect to the frontal plane, a normal first metatarsal will bepositioned such that its crista prominence is generally perpendicular tothe ground and/or its sesamoid bones are generally parallel to theground and positioned under the metatarsal. This position can be definedas a metatarsal rotation of 0 degrees. In a misaligned first metatarsal,the metatarsal is axially rotated between about 4 degrees to about 30degrees or more. In some embodiments, the method involves anatomicallyaligning the metatarsal by reducing the metatarsal rotation from about 4degrees or more to less than 4 degrees (e.g., to about 0 to 2 degrees)by rotating the metatarsal with respect to the medial cuneiform.

Thus, in some applications of the technique of FIG. 19, the clinicianmoves the first metatarsal in at least one plane from an anatomicallymisaligned position with respect to the second metatarsal to ananatomically aligned position. The at least one plane may be one or moreplanes selected from the frontal plane, the transverse plane, and thesagittal plane. For example, the clinician may move the first metatarsalin any two of the three planes or even in all three of the planes toadjust the first metatarsal from an anatomically misaligned position toan anatomically aligned position. Rotating the first metatarsal in thefrontal plane may further rotate the sesamoid bones (e.g., tibialsesamoid bone and fibular sesamoid bone) from a misaligned position toan aligned position under the first metatarsal.

After suitably moving the first metatarsal relative to the secondmetatarsal, the joint between the first metatarsal and medial cuneiformmay be provisionally fixated and the first metatarsal and medialcuneiform compressed together (506). To provisionally fixate andcompress the bones together, a bone fixation pin may be driven into oneof the first metatarasal and the medial cuneiform. When the bonefixation pin is configured with a threaded leading end, the leading endmay be threadingly advanced into one of the bones (e.g., by rotating anddrilling the pin into the bone). Alternatively, the bone fixation pinmay be hammered into the bone. In either case, the bone fixation pin maybe advanced completely through a cross-section of the bone until the pinemerges on a generally opposite side of the bone. The fixation pin maybe further advanced through the bone until the leading end of the pincontacts the other bone (either the medial cuneiform or firstmetatarsal). The fixation pin may thereafter continue to be driventhrough the first bone and into the second bone until the collar on thepin presses against the bone the pin is inserted through. The collar mayprevent the pin from advancing farther through the first bone and,correspondingly, into the second bone (until the first bone is itselfmoved closed to the second bone).

In some applications of the technique, the space between the firstmetatarsal and medial cuneiform (e.g., tarsal-metatarsal joint) iscompressed by continuing to drive the bone fixation pin in the bones. Asthe pin is driven into the bone structure, the collar can bear and pressagainst an outer surface of the first bone, pushing the first bone intocontact with the second bone and thereby compressing the bones together.The amount of compression can be controlled by controlling the depth thefixation pin is driven into the second bone. In addition to compressingthe bones together, the bone fixation pin can provisionally fixate, orhold, the bones in alignment together (e.g., until permanent fixation).

In different applications of the technique of FIG. 19, one or more bonefixation pins are inserted into the first metatarsal and the medialcuneiform to compress the bones together. In one example, one bonefixation pin is inserted into and through the first metatarsal andfurther into the medial cuneiform. In addition, a second bone fixationpin is inserted into and through the medial cuneiform and further intothe first metatarsal. Both bone fixation pins are then driven (e.g.,sequentially) toward the tarsal-metatarsal joint to bi-directionallycompress the bones together.

Following compression, the corrected position of the first metatarsalcan be permanently fixated by fixing the position of the firstmetatarsal with respect to the medial cuneiform (508). In some examples,permanent fixation involves detaching an implantable portion of the oneor more bone fixation pins inserted into the first metatarsal and medialcuneiform from a remaining portion of the pins. Additionally oralternatively, one or more bone plates can be applied across thetarsal-metatarsal joint and the provisional bone fixation pins removed.For example, a first bone plate may be positioned on a dorsal-medialregion of the first metatarsal and on the medial cuneiform while asecond bone plate is positioned on a medial-plantar region of the firstmetatarsal and on the medial cuneiform. In these applications, thesecond bone plate may or may not be a helical-shaped bone plateextending from a medial region of the medial cuneiform to a plantarregion of the first metatarsal across the joint.

Thus, embodiments of the invention are disclosed. Although the presentinvention has been described with reference to certain disclosedembodiments, the disclosed embodiments are presented for purposes ofillustration, and not limitation, and other embodiments of the inventionare possible. One skilled in the art will appreciate that variouschanges, adaptations, and modifications may be made without departingfrom the spirit of the invention.

1. A method of compressing adjacent bone portions, comprising the stepsof: providing a bone fixation pin having a length, a threaded endportion, and a collar; driving the threaded end portion into a firstbone portion; driving the threaded end portion through the first boneportion; driving the threaded end portion into a second bone portionuntil the collar is in apposition to the first bone portion; and furtherdriving the threaded end portion into the second bone portion tocompress together the first bone portion and the second bone portion. 2.The method of claim 1, wherein, after driving the threaded end portioninto the first bone portion and prior to driving the threaded endportion into the second bone portion, the position of the first boneportion is adjusted relative to the position of the second bone portion.3. The method of claim 1, wherein the first bone portion is one of afirst metatarsal and a medial cuneiform the second bone portion is theother of the first metatarsal and the medial cuneiform.
 4. The method ofclaim 3, wherein the first bone portion is the first metatarsal and thesecond bone portion is the medial cuneiform.
 5. The method of claim 1,wherein driving the threaded end portion into the second bone portionuntil the collar is in apposition to the first bone portion comprisesdriving the threaded end portion into the second bone portion until thecollar contacts the first bone portion, and further driving the threadedend portion into the second bone portion to compress together the firstbone portion and the second bone portion comprises driving the collaragainst the first bone portion and advancing the first bone portion intocontact with the second bone portion.
 6. The method of claim 1, whereinthe bone fixation pin comprises a shaft, the threaded end portion is ona leading end of the shaft, and the collar comprises a region of theshaft having a greater cross-sectional dimension than a remainder of theshaft.
 7. The method of claim 6, wherein the shaft is configured to bedetached proximally of the collar, thereby providing an implantableportion and a removable portion, and further comprising, subsequent tofurther driving the threaded end portion into the second bone portion,detaching the removable portion of the shaft proximally of the collar.8. The method of claim 7, wherein the shaft comprises a main driveengagement surface on a proximal end of the shaft and a secondary driveengagement surface on the collar, the secondary drive engagement surfacebeing configured to drive the implantable portion of the shaft afterdetaching the removable portion.
 9. The method of claim 1, wherein thefirst bone portion is one of a first metatarsal and a medial cuneiformthe second bone portion is the other of the first metatarsal and themedial cuneiform, and further comprising: preparing an end of the firstmetatarsal; preparing an end of the medial cuneiform opposing the end ofthe first metatarsal; and moving the first metatarsal from ananatomically misaligned position with respect to a second metatarsal toan anatomically aligned position.
 10. The method of claim 9, whereinpreparing at least one of the end of the first metatarsal and the end ofthe medial cuneiform comprises: positioning a projection of a block of acutting guide at least partially within a tarsal-metatarsal jointbetween the first metatarsal and medial cuneiform, the block beingpivotally connected to a first guide member; aligning the first guidemember at a location to be cut, wherein a first guide surface of thefirst guide member is positioned at the location to be cut; fixing thefirst guide member to a bone; and making a first cut at the location tobe cut by placing a cutting member in apposition to the first guidesurface.
 11. The method of claim 1, further comprising, subsequent tocompressing the first bone portion and the second bone portion together,applying one or more bone plates to the first bone portion and thesecond bone portion.
 12. A bone cutting guide comprising: a block; and afirst guide member pivotally attached to the block, wherein the firstguide member includes a first guide surface defining a first plane. 13.The bone cutting guide of claim 12, wherein the first guide memberfurther defines a second guide surface defining a second plane, andwherein the first plane is parallel to the second plane.
 14. The bonecutting guide of claim 12, wherein the first guide member includes afirst support having a first fixation aperture extending through thefirst support.
 15. The bone cutting guide of claim 14, wherein the firstguide member includes a second fixation aperture extending through thefirst support.
 16. The bone cutting guide of claim 15, wherein both thefirst fixation aperture and the second fixation aperture are located onan axis of the first support that extends perpendicular to the firstguide surface.
 17. The bone cutting guide of claim 12, wherein the firstguide member is pivotally attached to the block at a location on an endof the first guide member adjacent the first guide surface.
 18. The bonecutting guide of claim 13, further comprising: a second guide memberpivotally attached to the block, wherein the second guide memberincludes a third guide surface defining a third plane and a fourth guidesurface defining a fourth plane, and wherein the third plane is parallelto the fourth plane.
 19. The bone cutting guide of claim 18, wherein thesecond guide member further defines a fourth guide surface defining afourth plane, and wherein the third plane is parallel to the fourthplane.
 20. The bone cutting guide of claim 19, wherein the second guidemember includes a second support having a third fixation apertureextending through the second support.
 21. The bone cutting guide ofclaim 18, wherein the second guide member is pivotally attached to theblock at a location on the block radially spaced from a location on theblock where the first guide member is pivotally attached.
 22. The bonecutting guide of claim 18, wherein the first guide member and the secondguide member are attached to the block on a same end of the block andwherein their axes of rotation are parallel.
 23. The bone cutting guideof claim 18, wherein the second guide member is configured at anelevation along the block differing from an elevation along the block ofthe first guide member.
 24. The bone cutting guide of claim 12, whereinthe block includes a projection on an end of the block configured toextend into a space defined between bones.
 25. A method for cuttingbones, the method comprising the steps of: positioning a projection of ablock at least partially within a space defined between bones, the blockbeing pivotally connected to a first guide member; aligning the firstguide member at a location to be cut, wherein a first guide surface ofthe first guide member is positioned at the location to be cut; fixingthe first guide member to a bone; and making a first cut at the locationto be cut by placing a cutting member in apposition to the first guidesurface.
 26. The method of claim 25, wherein fixing the first guidemember to the bone comprises the steps of: inserting an end of a firstfixation pin through a first support of the first guide member at afirst fixation aperture extending through the first support; and fixingthe end of the first fixation pin to the bone.
 27. The method of claim25, wherein the space between bones is a joint between a cuneiform and ametatarsal.
 28. The method of claim 25, wherein aligning the first guidemember comprises the step of: pivoting the first guide member about theblock.
 29. The method of claim 25, wherein aligning the first guidemember comprises the step of: translating the first guide memberrelative to the block such that an elevation of the first guide memberis changed.
 30. The method of claim 25, further comprising the step of:removing the projection of the block from the space defined betweenbones while the first guide member is fixed to the bone.
 31. The methodof claim 25, further comprising the steps of: aligning a second guidemember pivotally connected to the block at the location to be cut,wherein a third guide surface of the second guide member is positionedat the location to be cut; fixing the second guide member to a bone; andmaking a second cut at the location to be cut by placing the cuttingmember in apposition to the third guide surface.
 32. The method of claim31, wherein aligning the second guide member comprises the step of:pivoting the second guide member about the block.
 33. The method ofclaim 31, further comprising the step of: removing the projection of theblock from the space defined between bones while both the first guidemember is fixed to the bone and the second guide member is fixed to thebone.
 34. A method of aligning bone, comprising the steps of: insertinga first fixation pin in a first bone portion at a first angle; insertinga second fixation pin in a second bone portion at a second angle, thefirst and second angles being different; and positioning the first andsecond bone portions with respect to each other by manipulating thefirst fixation pin and the second fixation pin.
 35. The method of claim34, wherein positioning includes at least one of a rotationaladjustment, a translational adjustment, or an elevational adjustmentbetween the first bone portion and the second bone portion.
 36. Themethod of claim 34, wherein positioning includes rotationally aligningthe first fixation pin and the second fixation pin.
 37. The method ofclaim 34, wherein the first fixation pin is inserted through a fixationaperture of a first guide member and the second fixation pin is insertedthrough a fixation aperture of a second guide member.